a frequently unrecognised condition Dr Tim Poate Consultant in Oral Medicine Kings College Hospital The Lister Hospital Chelsea Causes of a sore mouth Ulcers Mucosal diseases Lichen ID: 434068
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Burning Mouth Syndrome- a frequently unrecognised condition
Dr Tim Poate
Consultant in Oral Medicine
King’s College Hospital
The Lister Hospital, ChelseaSlide2
Causes of a sore mouth
Ulcers
Mucosal diseases (Lichen
planus
)
Cancer
Infections (thrush)
Burning Mouth Syndrome
Anaemia
Geographic tongue
Xerostomia
Trauma
DrugsSlide3
BMS symptoms
Burning
Saliva feels
different
Abnormal
tasteSlide4
BMS symptoms 2Feeling of sandpaper
Teeth are coated
Bad breath
Scalded
Peeling
Raw
Lumpy
Feeling of cracks / ulcers
Mouth feels dirtySlide5
Different names for BMS
‘Glossodynia’
‘Stomatodynia’
‘Oral dysaesthesia’
‘Burning Mouth Syndrome’
‘Burning tongue’Slide6
Sites affectedSlide7
BMS – classical featuresUsually womenUsually menopausal / post-menopausal
Have often had the symptoms for months / years
Have often seen many doctors / dentists / specialists
Often have been repeatedly told that nothing is wrong
May have been given repeated courses of antibiotic or antifungal therapy without benefitSlide8
BMS – classical featuresOften left thinking that everyone thinks that you are making it up or it is ‘all in the head’Often think that there is a serious cause that has not yet been found
Often worried that it is due to cancer
Often has become a considerable cause of frustration, concern, anger, depression with a considerable impact on mood, social life, relationships and enjoyment of life.Slide9
BMS - timingType 1 Pain-free on awakening
Burning commences in late morning Increase in severity throughout day
Reaches a peak in the evening.
Type 2
Continuous symptoms throughout the dayType 3 Intermittent symptomsSlide10
BMS – common associations
Stress
Depression
Other chronic pains
Irritable bowel Syndrome
Chronic fatigue
AnxietySlide11
BMS causes
Neuropathic
Hormonal
PsychogenicSlide12
How common is BMS?
1427 subjects
758 Women
669 Men
Age range 20-69PDH service registersSwedenExamined & interviewed
Diagnosed with BMSBergdahl, Bergdahl
Joral Pathol Med 1999; 28:350-4.Slide13
What investigations are typically performed?Saliva test / swab
Assess saliva flow rate
Exclude raised candida count
Blood test
Exclude anaemia or haematinic deficiency Others - as indicated to exclude other causes Slide14Slide15
Treatment
Discussion & reassurance
Symptomatic
Drugs
PsychologicalSlide16
BMS - TreatmentDiscussion & reassuranceCorrect diagnosis
Reassurance
Explanation
Correct any abnormal findings (
eg candida, iron)Stress reductionRelaxationSlide17
BMS treatment
Discussion & reassurance
Drugs
Psychological
SymptomaticSlide18
Antidepressant treatment for BMSLow dose
Minimal side effects
Essential information for BMS patients -
Needs to be taken daily for many months
May take 2-3 months for effect to beginNot addictiveWhen result achieved, and after maintaining results for several months, may be stopped / reduced / continuedSlide19
Spontaneous remissionBurning Mouth Syndrome: a retrospective study investigating spontaneous remission and response to treatments. Sardella al.
Oral Diseases (2006)12,152-5.Slide20
BMS data for patients with over 3 months follow up at KCHSlide21
BMS data for patients with over 3 months follow up at KCHSlide22
What achieves good results ?Discussion & reassuranceSymptomatic treatment
Drugs -
explanation
Psychological therapy -
availabilitySlide23
Annual BMS Patient Education DayKing’s College Hospital, LondonSlide24
Burning Mouth SyndromeVery distressing condition despite normal appearance of mouthCondition with considerable impact on sufferer and familySufferers have often gone years undiagnosed despite seeing many healthcare professionals
Correct diagnosis and reassurance (especially that cancer has been excluded) is vital
Steps to reduce stress and increase relaxation may help
Treatment is available
Results may take months or even years to achievePain often not completely resolvedHalving the severity of pain is a good resultSlide25
SummaryIncreased awareness about Burning Mouth Syndrome in Jersey
Consider BMS in patients with symptoms in absence of clinical findings
Exclude other causes of a sore mouth -
candidosis
, anaemia, mucosal diseaseReassuranceProvide symptomatic treatmentConsider associated factors – stress, anxiety, depressionConsider drug therapy, psychological therapyConsider referralSlide26
Burning Mouth SyndromeDr Tim Poate
King’s College Hospital, London
The Lister Hospital, Chelsea
t.poate@nhs.net
www.oralmedicinelondon.co.uk